A prospective cohort study of human papillomavirus-driven oropharyngeal cancers: implications for prognosis and immunisation

Wakeham, K. et al. (2019) A prospective cohort study of human papillomavirus-driven oropharyngeal cancers: implications for prognosis and immunisation. Clinical Oncology, 31(9), e132-e142. (doi: 10.1016/j.clon.2019.05.010) (PMID:31248692)

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Abstract

Aims: Oropharyngeal cancer (OPC) is increasing on a global scale, including the component driven by high-risk human papillomavirus (HR-HPV); contemporary data that provides insight into the prognosis of this disease in addition to the fraction attributable to HR-HPV are essential to inform primary and secondary disease management strategies. Materials and methods: A population-based cohort of 235 patients diagnosed with OPC between 2013 and 2015 in Scotland was assessed for HPV status using molecular genotyping. Associations between HR-HPV status and key clinical and demographic variables were estimated using the Pearson chi-squared test. Rates of overall survival and progression-free survival were estimated and visualised using Kaplan–Meier curves. Results: HPV DNA (largely HPV 16) was identified in 60% of cases. After adjustment for age, gender, deprivation, smoking, alcohol consumption and tumour stage, patients with HR-HPV-positive OPC had an 89% reduction in the risk of death (hazard ratio = 0.11, 95% confidence interval 0.05–0.25) and an 85% reduction in the risk of disease progression (hazard ratio = 0.15, 95% confidence interval 0.07–0.30). HPV positivity was not associated with age, deprivation or smoking status, whereas those who reported excess alcohol consumption were less likely to be positive for HR-HPV. Conclusions: The prevalence of HR-HPV-associated OPC is high in Scotland and strongly associated with dramatically improved clinical outcomes, including survival. Demographic/behavioural variables did not reliably predict HPV positivity in this cohort, which underlines the importance of laboratory confirmation. Finally, the dominance of HPV 16 in OPC indicates the significant impact of prophylactic immunisation on this disease.

Item Type:Articles
Additional Information:This research was funded by the Cancer Research UK, Development Fund.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cuschieri, Dr Kate and Graham, Professor Sheila and Bell, Dr Sarah and Wakeham, Dr Katie and McPhaden, Dr Allan and Pollock, Dr Kevin and Conway, Professor David
Authors: Wakeham, K., Pan, J., Pollock, K. G., Millan, D., Bell, S., McLellen, D., McPhaden, A., Conway, D. I., Graham, S. V., Kavanagh, K., and Cuschieri, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
Journal Name:Clinical Oncology
Publisher:Elsevier
ISSN:0936-6555
ISSN (Online):1433-2981
Published Online:25 June 2019
Copyright Holders:Copyright © 2019 Elsevier Ltd on behalf of The Royal College of Radiologists
First Published:First published in Clinical Oncology 31(9): e132-e142
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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